Brain Tumors in Children

What is a brain tumor?

A brain tumor is an abnormal growth of tissue in the brain. The brain is part of the central nervous system (CNS). The CNS also includes the spinal cord. The main parts of the brain are:

Cerebrum. This is the front of the brain. The cerebrum has two sides, the right and left hemispheres. It controls thoughts, emotions, and speech, and movement. It also helps with understanding information from the senses. This includes seeing, hearing, smelling, touching, and feeling pain.

Cerebellum. This is the back of the brain. It organizes muscle movement and helps to maintain posture, balance, and equilibrium.

Brainstem. This is the base of the brain. It includes the midbrain, the pons, and the medulla. It is the part of the brain that connects to the spinal cord. It plays a part in controlling muscles and sensations from the body. Part of the brainstem helps control breathing and the heart beat. Many of the cranial nerves start in the brain stem. The cranial nerves carry messages from different parts of the body to the brain

Brain tumors start in the cells of the brain. They can be either of the below:

Benign. This kind of tumor doesn’t contain cancer cells. In most cases, once a benign tumor is removed, it doesn’t grow back. Most benign brain tumors don’t grow into nearby tissue. These tumors can cause symptoms depending on their size and location in the brain.

Malignant. This kind of tumor does contain cancer cells. Malignant brain tumors usually grow fast, and grow into nearby tissue. Malignant brain tumors don’t usually spread to other areas of the body. They may grow back after treatment.

Brain tumors can occur at any age. Brain tumors that occur in infants and children are very different from adult brain tumors.

The most common type of brain tumor is a glioma. Gliomas begin from glial cells, which make up the supportive tissue of the brain. There are different types of glioma:

Astrocytoma. This type of tumor forms from astrocytes, a type of glial cells. It is the most common brain tumor in children. It is grows most often in the cerebellum.

Brain stem glioma. This tumor is found in the brain stem. Most brain stem tumors can’t be removed with surgery.

Oligodendroglioma. This tumor grows in the cells that make the fatty covering of nerve cells called oligodendrocytes. It usually grows slowly. But it usually grows into brain tissue. This makes it very difficult to remove with surgery.

Ependymoma. This usually grows in the lining of the ventricles that hold cerebrospinal fluid (CSF), or in the spinal cord. In children, they are usually near the cerebellum. They often block the flow of the CSF, the fluid that surrounds the brain and spinal cord. This may cause increased pressure in the skull.

Optic nerve glioma. This kind of tumor is found in or around the nerves that send messages from the eyes to the brain. It often affects vision. It can also affect hormones since it’s usually at the base of the brain where hormone control is located.

Other types of brain tumors include:

Primitive neuroectodermal tumor (PNET). This kind of tumor grows more often in children. It can grow anywhere in the brain in the primitive form of nerve cells. One type is the medulloblastoma. This kind of tumor start is found in the cerebellum. They are more common in children than in adults. They tend to grow and spread quickly, but they can often be treated effectively.

Craniopharyngioma. This kind of tumor starts near the pituitary gland. It is usually slow growing. But it can cause symptoms if it presses on the pituitary gland or on nearby nerves. This type of tumor is benign.

Mixed glial and neuronal tumors. These tumors are made up of glial and nerve cells.

Choroid plexus tumor. This is a rare tumor that starts in the ventricles of the brain. It’s also benign.

Schwannoma. This kind of tumor starts in myelin-making cells that surround certain nerves. It’s most common in the nerve in the inner ear that helps with balance. If it grows there, the tumor is called a vestibular schwannoma or an acoustic neuroma. This type of tumor is usually benign.

What causes a brain tumor?

Most brain tumors are caused by abnormal genes or chromosomes. What causes them to be abnormal is usually not known. Some chemicals may play a part in gene changes. Research is ongoing.

Who is at risk for a brain tumor?

Children with certain genetic conditions have an increased risk for tumors of the central nervous system. This includes children with:

Neurofibromatosis

Von Hippel-Lindau disease

Li-Fraumeni syndrome

Retinoblastoma

Children who have had radiation therapy for other cancers of the head are also at an increased risk for a new brain tumor.

What are the symptoms of a brain tumor?

Symptoms vary depending on size and location of tumor. Symptoms can occur a bit differently in each child.

Growing tumors may cause increased pressure on the brain in the limited space in the skull. This is called increased intracranial pressure or ICP. This isn’t usually the case in babies, since their skull bones haven’t fully grown together. The pressure on the brain may cause symptoms such as:

Headache

Enlarged head, especially in babies

Nausea and vomiting

Personality changes

Irritability

Drowsiness

Seizures

Coma

Symptoms of brain tumors in the cerebrum can include:

Seizures

Changes in eyesight or hearing

Trouble talking

Weakness or paralysis

Mood changes, such as feeling depressed

Symptoms of brain tumors in the cerebellum can include:

Trouble swallowing

Trouble with eye movement

Changes in speech

Clumsy movements of the hands, arms, feet, or legs

Problems walking (ataxia)

Symptoms of brain tumors in the brainstem can include:

Weakness

Problems walking (ataxia)

Muscle stiffness

Trouble with eye or other facial movement

Trouble swallowing

Double vision

Hearing loss

The symptoms of a brain tumor can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is a brain tumor diagnosed?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child. This will include a neurological exam. The exam tests reflexes, muscle strength, eye and mouth movement, and coordination. Your child's healthcare provider may refer your child to a cancer specialist (oncologist). Your child may have tests such as:

CT scan. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body.

MRI. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. Contrast dye may be injected into your child's vein. It helps cancer cells be seen more clearly.

Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.

Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.

Biopsy. Tumor cells are removed and sent to a lab for testing. This is done to determine the type of tumor and how quickly it is likely to grow.

Blood tests. Blood tests may be done to check for substances that are released by some tumors. These are called tumor markers.

How is a brain tumor treated?

If your child has been diagnosed with a brain tumor and time allows, you may want your child to see a different oncologist (get a second opinion) before beginning treatment. In fact, your insurance company might require a second opinion.

Treatment may include one or more of the below:

Surgery. Surgery is usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible, while keeping brain function.

Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth.

Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing.

High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.

Other treatments may include:

Corticosteroids. These treat and prevent swelling in the brain.

Antiseizure medicine. These treat and prevent seizures.

Ventriculoperitoneal (VP) shunt. A long tube called a shunt may be placed to remove extra fluid from the inside the brain. This helps control the pressure.

Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

Getting medical treatment right away is important for the best prognosis.

Ongoing follow-up care during and after treatment is needed.

New treatments are being tested to improve outcome and to lessen side effects.

What are possible complications of a brain tumor?

A child may have complications from the tumor or from treatment, such as:

Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech, or eyesight

Problems after surgery, such as infection, bleeding, and problems with general anesthesia

Infection and bleeding from chemotherapy

Delayed growth and development

Learning problems

Problems with reproduction (infertility)

Return of the cancer

Growth of other cancers

How is a brain tumor managed?

A child with a brain tumor needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. For example, your child may see an eye doctor (ophthalmologist) for vision problems.

Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists. If your child's speech is affected, he or she may need help from a speech therapist. Your child may also need the help of other therapists for learning or emotional problems.

You can help your child manage his or her treatment in many ways. For example:

Your child may have trouble eating. A dietitian may be able to help.

Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.

If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.

Get emotional support for your child. Find a counselor or child support group can help.

Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

Symptoms that get worse

New symptoms

Side effects from treatment

Key points about a brain tumor

Brain tumors start in the cells of the brain.

Brain tumors can grow at any age. Those that grow in infants and children are very different from those in adults.

The types of brain tumors are based on the cell type and location in the brain.

Some common symptoms of brain tumors are headache, nausea and vomiting, and trouble with movement.

Most children are treated with surgery, chemotherapy, and radiation therapy.

On-going follow-up is important in order to watch for effects of tumors or treatment and the cancer growing back.

Next steps

Tips to help you get the most from a visit to your child’s health care provider:

Before your visit, write down questions you want answered.

At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.